Provider First Line Business Practice Location Address:
12221 MO PAC EXPWY NORTH
Provider Second Line Business Practice Location Address:
DEPT OF DERMATOLOGY
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-901-4004
Provider Business Practice Location Address Fax Number:
512-901-3904
Provider Enumeration Date:
12/23/2005